Evaluation von Patientenpräferenzen für die Therapie der Hidradenitis suppurativa mittels Conjoint Analyse

Background: Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory skin disease characterized by nodules, abscesses, fistulas and scars in intertriginous areas and associated with significant physical disability and psychological burden. Treatment options comprise antibiotics, biologics and different surgical approaches. Integration of individual needs and preferences of patients into shared decision-making is indispendable. To date, there is only little scientific evidence on this issue. The aim of the study was to investigate patient preferences for treatment of HS with discrete choice experiments (DCE) and to examine the impact of patient and disease characteristics on these. Methods: Medicamentous and surgical treatment options of HS were described by three outcome attributes (probability of sustained therapeutic success, probability of mild adverse events and probability of severe adverse events) and two process attributes (duration of therapy or wound healing and treatment modality). Patient preferences were analyzed with computer-based DCE. Impact factors on preferred treatment options were assessed by descriptive subgroup analyses and multivariate regression analysis. Results: 216 patients were included into the study. Averaged across the total cohort, the probability of sustained therapeutic success was ranked as the most important attribute with a Relative Importance Score (RIS) of 36.2, followed by treatment modality (RIS: 24.0) and duration of therapy or wound healing (RIS: 19,9). Mild or severe adverse events were considered as less important (RIS: 10.7 or 9.3). Concerning the treatment modality, oral therapy was most popular (Part-worth Utility (PWU): 18,2), followed by subcutaneous injections (PWU: 2,9). Surgery with secondary wound closure was rated better than surgery with primary wound closure (PWU: -2,2 or -18,8). Preferences varied significantly upon age and affected body areas. Conclusions: Patients with HS attach the greatest importance to an effective, sustainable therapy and prefer medicamentous therapies, especially tablets, over surgery. To date there is an unmet need for these and for highly potent subcutaneously injectable biologics.